Acute transverse myelitis in COVID-19 infection.

A 60-year-old man presented to hospital with bilateral lower limb weakness, urinary retention and constipation. He had been diagnosed with COVID-19 10 days prior. Clinical examination revealed global weakness, increased tone, hyperreflexia and patchy paresthesia in his lower limbs bilaterally. Preliminary blood tests performed revealed a mildly elevated C reactive protein and erythrocyte sedimentation rate but was otherwise unremarkable. MRI scan of his whole spine demonstrated hyperintense T2 signal centrally from T7 to T10, suggestive of acute transverse myelitis. A lumbar puncture showed elevated protein count but normal glucose and white blood cell count. Serological testing for other viruses was negative. His neurological symptoms improved significantly after treatment with intravenous methylprednisone. This case highlights a potential neurological complication of COVID-19 infection.

Risk factor profile in Chinese-Australian stroke patients living in Sydney.

AIM: To examine and compare stroke risk factors and their management in stroke patients of Chinese descent versus English-speaking background (ESB)-Australian patients. METHODS: Cohort study. Fifty-one Chinese-Australians and 119 ESB-Australians who were admitted to hospitals within Sydney metropolitan area with a recent acute ischaemic or haemorrhagic stroke were recruited. RESULTS: Chinese-Australian patients tended to have a favourable smoking (0% current smokers vs 15%, P = 0.036) and drinking (5% current medium/heavy drinkers vs 17%, P = 0.005) pattern compared with the Australian patients. The prevalence of diabetes mellitus was higher in Chinese-Australians (31% vs 10%, P = 0.003). The management of hypertension and atrial fibrillation (AF) in Chinese-Australians was suboptimal (19% untreated hypertension vs 8%, P = 0.102; 78% AF not on Warfarin vs 51%, P = 0.264). CONCLUSION: The findings of this study suggest that targeting specific stroke prevention strategies may be useful for Chinese-Australians. Larger-scale studies need to be conducted to confirm these findings.

Axonal function in a family with episodic ataxia type 2 due to a novel mutation.

Episodic ataxia type 2(EA-2) is a rare, autosomal dominant disorder characterised by recurrent episodes of ataxia and dysarthria,due to mutations in the CACNA1A gene on chromosome 19 encoding voltage-dependent Ca2+ channels. The aim of the present study was to explore whether axonal membrane properties, assessed using nerve excitability techniques, were abnormal in patients with EA-2 . Nerve excitability techniques were applied to the median nerve of three individuals from three generations of a single family, all of whom had typical features of EA-2. This family was found to have a novel mutation at codon 1451 of the Ca2+ channel alpha 1A subunit. Nerve excitability testing demonstrated significant abnormalities,with all patients outside the normal 95 % confidence limits in having a high rheobase and reduced early hyperpolarizing threshold electrotonus. On average there were also significant reductions in refractoriness,late sub excitability and early depolarizing threshold electrotonus. Mathematical modelling indicated that a similar pattern of abnormalities may result from a reduced voltage dependence of slow K+ channels (KCNQ channels). There are significant and distinctive changes in peripheral nerve excitability in EA-2 patients,which are presumably induced indirectly. These findings raise the possibility that excitability testing may prove a convenient screening test for patients with this suspected channelopathy.